The use of ultrasound and magnetic resonance imaging in the management of hidradenitis suppurativa: a narrative review

Abstract

Hidradenitis suppurativa (HS) is a chronic, inflammatory follicular skin disease that frequently affects the apocrine gland-bearing skin of the axillary, inguinal and anogenital regions. HS has a significant impact on the psychosocial health and quality of life of patients. Diagnosis of HS is typically clinical, and reliant on the ability of physicians to recognize the signs of HS. However, lesions may present at the dermal and subcutaneous skin layers, which cannot be diagnosed by clinical examination alone. Further, the complexity of the clinical presentation of HS can lead to misdiagnosis and delay of diagnosis and appropriate treatment. Imaging is an important tool that can address these issues by detecting inflammatory activity and the early subclinical and dermal features of HS, and accurately characterizing lesional morphology, thereby informing on optimal therapeutic strategies. Overall, imaging is a key tool that can be used in conjunction with clinical examination to improve the management of HS by providing additional information to physicians, and thus optimize clinical decision-making. In this narrative review, we provide an overview of the general role of imaging in the management of HS, and we illustrate HS-specific applications of two pertinent imaging modalities, ultrasound (US) and magnetic resonance imaging (MRI). Finally, based on the literature, we summarize their uses in HS and provide considerations relating to standardizing the practice of US and effectively implementing the use of imaging in the management of HS.

The Role of Ultra-High-Frequency Ultrasound in Pyoderma Gangrenosum: New Insights in Pathophysiology and Diagnosis

“…The use of US, particularly UHFUS examination, has demonstrated its potential to revolutionize the field of dermatology by providing valuable insights into the development of an objective and standardized staging method for various skin disorders [31][32][33][34]. In this context, our study represents the first experience with UHFUS in patients affected by PG lesions presented in the literature.…”

Uncovering the burden of hidradenitis suppurativa misdiagnosis and underdiagnosis: a machine learning approach

“…Therefore, there is a need to reduce diagnostic delays by supporting accurate and early recognition of HS to limit disease progression and manage the comorbidity burden ( 14 , 16 ). Some studies have reported the use of ultrasound (US) imaging as a characterizing diagnostic tool in conjunction with clinical examination to reduce the uncertainty of HS diagnosis and inform on optimal therapeutic strategies, primarily by detecting inflammatory activity and the early subclinical and dermal features of HS and accurately characterizing lesion morphology ( 17 – 19 ). The use of US for diagnosis is a promising approach to both diagnosis and staging; however, its application in the practice setting is limited at present because it has not yet been standardized or validated.…”

Dermatological ultrasound in assessing skin aging

“…In oncology, it aids in early diagnosis, provides critical information about tumor depth, locoregional staging, prognosis, surgical planning and postoperative assessment of treatment outcomes (4). Within clinical Dermatology, US finds utility in the diagnosis of benign tumors, characterizing nail pathology, differentiating autoimmune bullous diseases and monitoring inflammatory conditions such as psoriasis, atopic dermatitis, morphea and hidradenitis suppurativa (5)(6)(7). In aesthetic medicine, the US serves as a valuable tool for guiding filler injections, managing complications, and tracking treatment outcomes (3,8).…”